Provider First Line Business Practice Location Address:
1646 MONROE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92116-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-309-2981
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2010